Drews Marcel Alexander, Baumgarten Alexander, Zensen Sebastian, Opitz Marcel, Bos Denise, Zimmer Lisa, Ugurel Selma, Haubold Johannes, Schadendorf Dirk, Livingstone Elisabeth, Schaarschmidt Benedikt M
Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany.
Department of Dermatology, University Hospital Essen, Essen, Germany.
Eur Radiol. 2025 May 1. doi: 10.1007/s00330-025-11642-w.
BRAF/MEK inhibitors (BRAFi/MEKi) and PD-1 and CTLA-4 immune checkpoint inhibitors (ICI) have revolutionized malignant melanoma treatment and improved patients' clinical outcome significantly. However, these therapies are associated with substance class-specific side effects. Here, selected cases indicate a correlation between the incidence of mesenteric panniculitis (MP) and BRAFi/MEKi treatment. As MP can mimic or conceal underlying malignancy, the aim of the present study was to confirm a potential correlation with BRAFi/MEKi or ICI in a retrospective, observational analysis of melanoma patients.
In a monocentric retrospective study, abdominal CTs of 490 melanoma patients receiving first-line treatment with ICI (nivolumab, ipilimumab, pembrolizumab, nivolumab/ipilimumab) or BRAFi/MEKi (dabrafenib/trametinib, vemurafenib/cobimetinib, encorafenib/binimetinib) in the adjuvant or advanced situation were evaluated for MP development comparing baseline imaging prior therapy start and follow-up imaging under therapy. MP was defined as an unilocular mesenteric mass characterized by small tissue nodules with increased density of the adjacent fat and a surrounding pseudo-capsule.
384 melanoma patients with ICI (161 women, median age at therapy start: 62 years, IQR: 21 years) and 106 patients with BRAFi/MEKi first-line therapy (46 women, median age: 58 years, IQR: 18 years) were evaluated. MP incidence was significantly higher following BRAFi/MEKi treatment compared to ICI (7.5% vs. 2.9%, p = 0.04). No significance was detected comparing time until MP development from therapy start (174 days, IQR: 518 days [BRAFi/MEKi] vs. 207 days, IQR: 298 days [ICI], p > 0.05).
Our study demonstrates a significant increase in MP development following BRAFi/MEKi treatment compared to ICI in patients with melanoma. As this benign condition can mimic or even conceal malignancy, awareness of its appearance is important.
Question BRAF/MEK and immune checkpoint inhibitors have revolutionized melanoma treatment but are associated with various side effects, yet data regarding the development of mesenteric panniculitis are scarce. Findings BRAF/MEK inhibitor treatment is associated with a significantly higher rate of mesenteric panniculitis compared to immune checkpoint inhibitor treatment in advanced melanoma. Clinical relevance BRAF/MEK inhibitor-treated patients are at risk for development of mesenteric panniculitis. As this benign finding can mimic or conceal malignancy, awareness of it is important especially in these patients.
BRAF/MEK抑制剂（BRAFi/MEKi）以及PD-1和CTLA-4免疫检查点抑制剂（ICI）彻底改变了恶性黑色素瘤的治疗方式，并显著改善了患者的临床结局。然而，这些疗法会产生特定药物类别的副作用。在此，部分病例表明肠系膜脂膜炎（MP）的发生率与BRAFi/MEKi治疗之间存在关联。由于MP可模仿或掩盖潜在的恶性肿瘤，本研究的目的是通过对黑色素瘤患者进行回顾性观察分析，确认其与BRAFi/MEKi或ICI之间是否存在潜在关联。
在一项单中心回顾性研究中，对490例接受ICI（纳武单抗、伊匹单抗、帕博利珠单抗、纳武单抗/伊匹单抗）或BRAFi/MEKi（达拉非尼/曲美替尼、维莫非尼/考比替尼、恩考芬尼/比美替尼）一线治疗的黑色素瘤患者的腹部CT进行评估，以比较治疗开始前的基线影像与治疗期间的随访影像，观察MP的发生情况。MP被定义为单房性肠系膜肿块，其特征为小组织结节，相邻脂肪密度增加，周围有假包膜。
对384例接受ICI治疗的黑色素瘤患者（161例女性，治疗开始时的中位年龄：62岁，四分位间距：21岁）和106例接受BRAFi/MEKi一线治疗的患者（46例女性，中位年龄：58岁，四分位间距：18岁）进行了评估。与ICI治疗相比，BRAFi/MEKi治疗后MP的发生率显著更高（7.5%对2.9%，p = 0.04）。比较从治疗开始到MP出现的时间，未发现显著差异（174天，四分位间距：518天[BRAFi/MEKi]对207天，四分位间距：298天[ICI]，p > 0.05）。
我们的研究表明，与ICI治疗相比，黑色素瘤患者接受BRAFi/MEKi治疗后MP的发生率显著增加。由于这种良性情况可模仿甚至掩盖恶性肿瘤，了解其表现很重要。
问题 BRAF/MEK和免疫检查点抑制剂彻底改变了黑色素瘤的治疗方式，但会产生各种副作用，然而关于肠系膜脂膜炎发生情况的数据却很稀少。发现 与晚期黑色素瘤的免疫检查点抑制剂治疗相比，BRAF/MEK抑制剂治疗与肠系膜脂膜炎的发生率显著更高相关。临床意义 接受BRAF/MEK抑制剂治疗的患者有发生肠系膜脂膜炎的风险。由于这一良性发现可模仿或掩盖恶性肿瘤，了解这一点很重要，尤其是在这些患者中。
